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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Matt Carnahan <br /> Permittee Company: Oldcastle SW Group, Inc. dba Four <br /> Corners Materials <br /> Address: P.O. Box 1969 <br /> Bayfield, CO 81122-1969 <br /> Phone Number: (970)247-2172 <br /> Fax Number: (970)259-3631 <br /> Email Address: Mcamahan@4cornersmaterials.com <br /> 1,the undersigned,hereby state that the information provided in this report is true and accurate, and that site operations are <br /> being conducted in ccordance with the Division approved mining and reclamation plans. <br /> �� �v,�t i1ra �1�'r21 le- 1 IAE Zo!Z <br /> Signature of Pe mittee Corporate Officer,Owner,or Documented Desiinee Date <br /> M-AF-01 <br />